Compared Healing of Mandibular Condylar Fractures with Open and Closed Reduction Surgical Methods (Radiological Analysis, Gray Scale)

Compared Healing of Mandibular Condylar Fractures with Open and Closed Reduction Surgical Methods (Radiological Analysis, Gray Scale) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Compared Healing of Mandibular Condylar Fractures with Open and Closed Reduction Surgical Methods (Radiological Analysis, Gray Scale) Ainu Zuhad Sukaton, Poerwati Soetji Rahajoe, Yosaphat Bayu Rosanto This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7613590/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study aimed at comparing the bone healing process in mandibular condylar fractures treated with ORIF and closed reduction methods radiographically with the use of Gray Scale Value (GSV). Methods:The study involved 30 patients with condylar fractures who were treated and divided into two groups: Group A: Treatment with ORIF (15 patients); Group B: Treatment with closed reduction (15 patients). GSV analysis on orthopantomography (OPG) was presented in Pixel Value Ratio (PVR), which compared GSV value of fracture area and healthy bone. Observations were made on day 1, week 2, weeks 8-13, and >13 weeks postoperatively. Results: The majority of the subjects were male, 26-28 years of age on average, all with traffic accident trauma etiology. Results of repeated measure ANOVA showed that PVR value in both groups increased significantly at all observation times with P=0.000, and the PVR value in the ORIF group was higher. T-test results showed that PVR value in ORIF group was higher than closed reduction group at all observation times (0.001, 0.003, 0.005, and 0.018). Conclusion: GSV and PVR values in ORIF group were found higher than those in closed reduction group, which means that healing in ORIF group was better than in closed reduction group. mandibular condylar fracture Gray Scale Value ORIF closed reduction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Mandibular condylar fractures are the most common type of mandibular fracture, marking 52% of all mandibular fractures [ 1 ]. The management of condylar fracture remains in questions which one is better between open reduction internal fixation (ORIF) and closed methods. The ORIF method is more commonly used because it can reduce the duration of maxillomandibular fixation (MMF) placement, where patients are more comfortable, oral hygiene is easier to maintain, and jaw mobilization is faster. However, this method has several weaknesses such as the risk of facial nerve injury and postoperative infection. On the other hand, the closed method has the advantage of being more conservative and causing minimal risk, but the duration of MMF placement is longer which causes discomfort for the patient [ 2 ]. Bone healing in condylar fractures treated with ORIF is primary healing, referring to the healing process that occurs when bone fragments are reduced and fixed properly [ 3 ], radiologically 2–4 weeks after the fracture, the bone density increases at the fracture margin, indicating the formation of new bone that occurs until week 8 when the fracture line is eliminated [ 4 ]. Secondary bone healing occurs in fractures treated with the closed method, which takes place indirectly through the acute inflammatory process in the formation of hematoma, then undergoes coagulation and callus formation [ 3 ], radiologically, secondary healing occurs and emerges from the formation of callus at the fracture margin, which can be found between 2–4 four weeks after the fracture [ 4 ]. The most common study on condylar fracture healing is clinical evaluation. Radiographic evaluation of condylar fracture healing remains rare. Sukegawa's study [ 5 ] found good alignment in ORIF treatment compared to the non-fractured side using intraoperative CBCT. Meanwhile, according to Zhang [ 6 ], alignment was achieved but roughness occurred on the condylar surface using panoramic radiography. In contrast to these two researchers, Singh's study [ 7 ] showed that the visibility of the fracture line gradually disappeared three months after ORIF on panoramic radiographic examination. Unluckily, these studies cannot assess the stages of the bone healing process, and can only see the final results of treatment and are more subjective. Gray scale is a radiographic analysis to assess bone density by evaluating changes in gray gradation, thereby enabling a more objective assessment of the stages of the healing process. Gray scale analyzes the gray scale of each pixel on a radiograph with the help of digital image processing software for assessing bone density and bone thickness [ 6 , 8 ]. Shirvaikar [ 9 ] used grayscale analysis to study bone mineral density in long bones as a parameter for predicting fracture risk. Liu [ 10 ] used gray scale analysis to observe the distraction osteogenesis process using AP lateral radiographs. Another research group assessed the difference in the number of plates and the use of archbars on bone healing in parasymphyseal fractures using grayscale (in publication process) which found that there was no difference in fracture healing between the use of single plate combined with an archbar compared to that of two miniplates without an archbar and two miniplates with an archbar. No studies have been done on the healing of mandibular condylar fractures using grayscale analysis to assess the healing process of mandibular condylar fractures treated with ORIF and closed methods. This study aimed at observing the differences between the stages of bone healing in cases of mandibular condylar fractures treated with ORIF and closed methods. METHODS This retrospective cross-sectional study was conducted after obtaining approval from the Ethics Committee of the Faculty of Dentistry–Dental and Oral Hospital, Universitas Gadjah Mada (41/UN1/KEP/FKG-RSGM/EC/2025). The research samples were taken at Margono Soekarjo Regional General Hospital, Purwokerto, Central Java, Indonesia, and radiographic analysis was performed at Prof. Soedomo Dental Hospital, Faculty of Dentistry, Universitas Gadjah Mada. The evaluation of the healing process of mandibular condylar fractures using Gray Scale Value (GSV) and Pixel Value Ratio (PVR) analysis was performed by a radiology specialist (SFD) on OPG following the predetermined Region of Interest (ROI). Research Samples The research samples consist of medical records of patients diagnosed with condylar fractures treated between 2017 and 2024, with inclusion criteria: (a) Complete patient medical records, (b) Patients had orthopantomography (OPG) X-rays, (c) OPG radiograph quality is eligible for analysis, and (d) Patients had no systemic diseases. Exclusion criteria comprise: (a) Patients with infectious complications and (b) Patients with pathological causes of fracture. Thirty (30) samples involved in this study were calculated using an unpaired numerical analytical formula with 80% research power and a 95% confidence level with a minimum sample size of 15 per group: n1 = n2 = \(\:2{\left(\frac{\left(Z\propto\:+Z\beta\:\right)S}{X1-X2}\right)}^{2}\) Zα : alpha standard deviation with a confidence level of 95% or α = 5% Zβ : beta standard deviation S : combined standard deviation X1-X2 : minimum difference in significant means Determination of Region of Interest (ROI) (Figs. , , and ) The size of each ROI is 10x10 pixels (100 pixels). The determination of the ROI for the ORIF group differs from the one for the closed method group in order to minimize bias that may occur due to the determination of ROI [ 11 ]. In the ORIF group, 6 ROIs were determined: 2 ROIs on the fracture line, 2 ROIs on healthy bone in the superior and inferior fracture lines on the anterior plate, and another 2 ROIs on the healthy bone side in the superior and inferior fracture lines on the posterior plate (Fig. 1 ). ROI in the closed method group was determined in two ways consisting of superimposed and non-superimposed. In the superimposed case, the average ROI in the fracture area was calculated from ROI 1 and 2, then the average ROI in the non-fracture area was calculated from the average ROI 3, 4, 5, and 6. The average of the ROI in the fracture area and the non-fracture area becomes the average grayscale value (Fig. 2 ). In the non-superimposed case, there are 8 ROIs, in which 4 ROIs on the fracture line of the condyle and mandibular ramus and 4 ROIs in the non-fractured bone area on the condyle and mandibular ramus fragments. The average of ROI 1 to ROI 4 is the average gray scale value in the fracture area, while the average of ROI 5 to ROI 8 is the average gray scale value in the non-fracture area (Fig. 3 ) [ 12 ]. Gray Scale Value (GSV) Analysis (Geiger,2016) [ 11 ] Gray Scale Value (GSV) analysis on OPG radiographs used Image-J® software (Wayne Rasband, NIH, USA). Prior to performing GSV analysis, the OPG radiograph was first resized to 2976 x 1536 pixels and then converted to 8-bit image data with the conversion menu in Image-J to make sure that the OPG radiograph had 256 gray values ranging from 0 to 255, where 0 was black and 255 was white. GSV analysis was conducted on OPGs on observation day 1, week 2, weeks 8–13, and > 13 weeks postoperatively. Pixel Value Ratio ( PVR ) Analysis (Geiger,2016) [ 11 ] The Pixel Value Ratio (PVR) method is a technique for analyzing grayscale images by systematically observing changes in pixel values. PVR is an approach that emphasizes measuring the range of pixel values in grayscale images to identify variations in intensity and contrast. This technique can detect edges, contours, or patterns relevant to specific clinical conditions. The calculation of PVR was carried out on observation day 1, week 2, weeks 8–13, and > 13 weeks postoperatively using the following formula: PVR = GSV fracture/GSV healthy bone Statistical analysis The obtained data were analyzed with IBM SPSS Statistics 22 (IBM, United States). In this study, normal data distribution and sphericity of variance were fulfilled. The GSV and PVR data in the ORIF group and the closed reduction group were tested using Repeated Measure ANOVA (Analysis of Variance) based on observation time to identify the differences between the two groups and T-test to see the differences at each observation time between the ORIF and closed reduction groups. Pearson's correlation test was performed to determine the relationship between the increase in PVR and the observation time. RESULTS Research Sample Characteristics The research subjects were predominantly male in both groups, with an average patient age of 28.1 and 26.9 respectively, and no significant differences were found between the two groups. Similarly, other characteristics such as waiting time for surgery, etiology, operating time, and displacement showed no significant differences between the two groups (Table 1 ). The observation period was conducted on day 1, week 2, weeks 8–13, and > 13 weeks postoperatively (9.1 weeks on average), and more than 13 weeks postoperatively with an average observation time of 24.4 weeks. Table 1 Characteristics of Research Subjects (N = 30) Characteristics ORIF Closed reduction P Gender, N,(%) Male 10 (66.6) 10 (66.6 1.00 Female 5 (33.3) 5 (33.3) Age ( \(\:\stackrel{-}{x}\) ±SD) 28.1 ± 14.1 26.9 ± 12.9 0.94 Waiting time for Treatment, N,(%) 1 day 8 (53.3) 7 (46.6) 0.59 More than 3 days 7 (46.6) 8 (53.3) Etiology, N,(%) Multiple Traffic Accident 9 (60) 10 (66.6) 0.17 Single Traffic Accident 6 (40) 5 (33.3) Operating time, N,(%) ≤ 1 hour 7 (46.6) 8 (53.3) 0.72 > 1 hour 8 (53.3) 7 (46.6) Fracture Fragment Condition, N,(%) Displacement 10 (66.6) 8 (53.3) 0.46 Without displacement 5 (33.3) 7 (46.6) P: based on the chi-square test with α = 95% Grey Scale Value (GSV) GSV value on the fracture side in both the ORIF group (P = 0.015) and the closed reduction group (P = 0.000) showed a significant increase based on the observation time. When comparing the ORIF and closed reduction groups, the GSV value in the non-fracture area for both the ORIF and closed reduction groups revealed no significant increase based on observation time, with P value of 0.813 and 0.211 respectively (Table 2 and Fig. 4 ). In contrast to the GSV value in the non-fracture area, the mean GSV value in the fracture area in the ORIF group (121.16-135.38) was higher than that in the closed reduction group (105.25–134) (Table 2 and Fig. 4 ). The higher GSV value in the fracture area in the ORIF group indicated a faster trabecular bone formation process, indicating faster healing. On the fracture side, the GSV value of the ORIF group was higher than that of the closed reduction group, but a significant difference was found only on day 1. The non-fracture side showed no significant differences based on all observation times. Table 2 Average GSV Score in the ORIF and Closed Reduction Groups Follow-up Time ( \(\:\stackrel{-}{x}\) ±SD) Fracture (N = 30) Non Fracture (N = 30) ORIF ( \(\:\stackrel{-}{x}\) ±SD) Closed reduction ( \(\:\stackrel{-}{x}\) ±SD) P2 ORIF ( \(\:\stackrel{-}{x}\) ±SD) Closed reduction ( \(\:\stackrel{-}{x}\) ±SD) P2 Day 1 121,16 ± 10.2 105.25 ± 11.91 0.001** 145.2 ± 13.49 139.92 ± 8.00 0.201 Week 2 124.09 ± 12.19 121.65 ± 17.01 0.655 141.01 ± 14.84 143.35 ± 19.96 0.718 Weeks 8–13 (9.1 ± 1.5) 131.72 ± 16.9 125.81 ± 14.92 0.318 142.57 ± 20.92 139.87 ± 16.96 0.701 > 13 weeks (24.4 ± 7.6) 135.38 ± 11.91 134 ± 15.55 0.787 141.89 ± 11.98 143.7 ± 16,98 0.739 P 1 0.015* 0.000** 0.813 0.211 Description: P 1 : Based on Repeated Measure Anova test, P 2 : based on independent T test with α = 95%. *: Significant Pixel Value Ratio (PVR) Evaluation of PVR at each observation time on day 1, week 2, weeks 8–13, and > 13 weeks showed that PVR value increased (ORIF from 0.84 to 0.95 and closed reduction from 0.75 to 0.93 with P value of 0.00 and 0.00, respectively), with higher PVR value in the ORIF group. In this study, PVR value in the ORIF group was proven to be higher at all observation times (day 1 showed ORIF 0.84 and closed reduction 0.75 with P = 0.001), (week 2 revealed ORIF 0.88 and closed reduction 0.85 with P = 0.003), (weeks 8 to 13 showed ORIF 0.93 and closed reduction 0.90 with P = 0.005) and (> 13 weeks revealed ORIF 0.95 and closed reduction 0.93 with P = 0.018)) (Table 3 ). Pearson's correlation test showed a strong positive relationship between the increase in PVR and the observation time in the ORIF group (P = 0.000 and R = 0.866) and the closed reduction group (P = 0.000 and R = 0.874), which means that as time increased, the PVR value in both groups also increased (Table 3 and Fig. 5 ). Table 3 Average PVR Score in the ORIF and Closed Reduction Groups Follow-up Time ( \(\:\stackrel{-}{x}\) ±SD) PVR (N = 30) P 2 ORIF ( \(\:\stackrel{-}{x}\) ±SD) Closed reduction ( \(\:\stackrel{-}{x}\) ±SD) Day 1 0.84 ± 0.02 0.75 ± 0.05 0.001** Week 2 0.88 ± 0.02 0.85 ± 0.03 0.003** Weeks 8–13 (9.07 ± 1.53) 0.93 ± 0.03 0.90 ± 0.02 0.005** > 13 weeks (24.42 ± 7.61) 0.95 ± 0.02 0.93 ± 0.02 0.018* P 1 0.000** 0.000** Description : P 1 : based on Repeated Measure ANOVA test, P 2 : based on independent T test with α = 95%. * : Significant DISCUSSION Proper treatment method for mandibular condylar fractures can result in faster healing, thereby preventing complications such as malocclusion, temporomandibular joint (TMJ) disorders, limited mandibular movement, and chronic pain [ 13 ] which can promote the patient's quality of life, reduce treatment costs, and shorten the duration of treatment. This study aimed at evaluating the differences in radiographic healing of mandibular condylar fractures between the ORIF and closed reduction methods. The subjects involved in the study were predominantly male (66.67%) aged 26–28 years with mandibular condylar fractures by traffic accidents. The results are similar to those of a study conducted by Kozakiewicz and Walczyk [ 14 ], that in developed countries, the case was more frequently in male (82%) with an average age of 33–40 years, but the etiology of mandibular condylar fractures is mostly caused by physical violence (51%). This difference in etiology is due to sociocultural differences between developed and developing countries, as stated in Roode's study¹ 5 that most people in developing countries use motorcycles as the main means of transportation. The results of this study showed that GSV value on the fracture side after treatment with ORIF was significantly higher than that obtained with the closed reduction method only on the first day of GSV observation (P = 0.001). Meanwhile, at week 2 (P = 0.655), 8 to 13 weeks (P = 0.318), and > 13 weeks (P = 0.787), the GSV value of the ORIF group was higher than that of the closed reduction group but it was not significant. The results indicate that on day 1, the ORIF group had higher bone density compared to the closed reduction group, because in ORIF treatment, no gap was formed in the fracture area, thereby increasing radiopacity and GSV value, as stated in Liu's study [ 10 ]. Treatment with ORIF is dominated by primary bone healing, through the remodeling of bone lamellae and Haversian canals due to the achieved reduction and fixation of fractured bones [ 16 ]. The bone on one side will come into contact with the other side to achieve mechanical continuity, then Haversian canals will form in the fracture area to fill the fracture area with bone matrix. This process allows for bone formation and new blood supply in the fracture area, which then transitions to the remodeling phase without the formation of callus [ 3 ]. The healing process of fractures in the closed reduction method occurs through secondary bone healing. Secondary bone healing undergoes four stages: on the first stage, acute inflammation occurs during the first five days, where hematoma forms and inflammatory mediators recruit inflammatory cells to clean up necrotic tissue; the second stage occurs on days 5–10, marked by the formation of soft callus; the third stage is the process of hard callus formation, which lasts until the fourth week [ 3 ]. The final phase is bone remodeling, which can last from months to years through the activity of osteoclasts and osteoblasts. This phase aims to restore the bone to its original structure, shape, and mechanical properties [ 17 ]. Observation of fracture healing using GSV analysis with the ImageJ software is easier and cheaper to perform, as well as more sensitive and objective in assessing changes in the degree of grayness that identify bone density conditions in radiographs in the bone formation process [ 11 ]. GSV analysis, however, depends on the quality of the radiograph image used and can vary in each parameter, such as contrast, voltage, current, exposure time, and patient position. The parameters can affect the quality of the radiograph image, resulting in the possibility of bias in the calculation. This study took samples from the same radiography laboratory and were examined by the same radiologist, and used PVR analysis to anticipate the weaknesses of GSV analysis to minimize bias. The healing process analysis in this study used the Pixel Value Ratio (PVR), which compares the GSV value on the fracture side with the healthy side to make it more representative per individual [ 11 , 18 ]. The PVR value in this study showed higher value in the ORIF group compared to the closed reduction group on all observation days: day 1, week 2, weeks 8 to 13, and > 13 weeks postoperatively with P value of P = 0.001, P = 0.003, P = 0.005, and P = 0.018, respectively, indicating earlier bone remodeling process in the ORIF group. The bone composition in the fracture area was denser, and the fracture line disappeared more quickly compared to the closed reduction group. This process indicates that the bone healing process was faster in the ORIF group [ 3 ]. The highest increase in PVR was found in the ORIF control group from week 2 to weeks 8 to 13 (0.88 ± 0.02–0.93 ± 0.03), while in the closed reduction group it was found from day 1 to week 2 (0.75 ± 0.05–0.85 ± 0.03). The difference in PVR increase between the two groups occurred because in the closed reduction group, inflammation and hematoma formation as a scaffold in the callus formation process occurred from day 1 to day 5. then from day 5 to day 10 soft callus was formed, followed by mineralization of the soft callus into hard callus, which continued until the fourth week of the fracture, causing the PVR value to increase significantly because the fracture gap began to fill with callus, which increased radioopacity. In contrast, the ORIF group did not undergo the callus formation process because there was no gap, so primary healing occurred from the first day of the fracture after treatment [ 3 , 17 , 19 ]. The highest increase in the ORIF group was observed in week 2–8 due to the maturation process of woven bone into lamellar bone 3,16 that increased radioopacity in the fracture area and was reflected in high PVR increase. Meanwhile, in the closed reduction group, week 2–8 marked the beginning of the bone remodeling process, resulting in a slowdown in PVR increase. The results of this study also support previous studies that examined clinical fracture healing, such as Rashid's study [ 1 ] which showed that the ORIF group had lower pain complications and wider mouth opening compared to the closed reduction group in the treatment of mandibular condylar fractures. Bansal [ 20 ] found a wider interincisal opening in patients with condylar fractures treated with ORIF compared to closed reduction. The same findings were also reported by Pandey [ 21 ] who found that the incidence of TMJ dysfunction and malocclusion after ORIF treatment was lower than that after closed reduction. This study also showed that PVR was found higher in the ORIF group than in the closed reduction group. Based on this description, it does not mean that treatment with closed reduction was worse than ORIF in cases of mandibular condyle fractures, because in some cases treatment with the ORIF method was impossible to carry out [ 18 ]. The choice of treatment method for mandibular condylar fractures is influenced by the indications and contraindications of each case, the patient's age, the severity of the fracture, and the condition of the patient's teeth [ 22 ]. The ORIF method may be preferable in certain cases, such as mandibular condylar neck fractures with minimal displacement and single-fragment fractures. Still, a more conservative approach using closed reduction remains a prudent choice in cases such as condylar head fractures, non-displaced condylar fractures, and condylar fractures in pediatric patients [ 23 ]. This retrospective cross-sectional study has several limitations, such as the inability to control variables that may affect fracture healing, including age range, fracture severity, surgical technique, observation time, and length of treatment, due to the use of secondary data. The samples in this study were taken over a specific period of time, restricting the ability to observe variables that affect bone healing over time [ 24 , 25 ]. CONCLUSION Analysis of Gray Scale Value (GSV) and Pixel Value Ratio (PVR) showed higher value in the ORIF group compared to closed reduction. This value indicates that the ORIF group had higher bone density (consisting of lamellar bone in the ORIF group and callus in the closed reduction group) during the bone healing process, meaning that the healing process of mandibular condylar fractures in the ORIF group was better than in the closed reduction group. Declarations Conflict of interest The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculty of Dentistry–Dental and Oral Hospital, Universitas Gadjah Mada (41/UN1/KEP/FKG-RSGM/EC/2025). Informed consent Additional informed consent was obtained from all patients for which identifying information is included in this article. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution AZS wrote a manuscript, PSR designed a research method and proposed a statistical method, AZS performed data collection and analysis, and PSR, YBR supervised the research. The authors read and approved the final manuscript. Acknowledgement Nil References Rashid M, Dhiman NK, Kumar N, Tiwari P, Jaiswara C, Vishwakarma AK, Shweta S, Hirani MS. Evaluation of condylar fractures management: Open vs. closed. IJDSIR. 2020;3(5):27–37. Dergin G, Emes Y, dan, Aybar B. (2019) Evaluation and management of mandibular fracture, Trauma in Dentistry, IntechOpen. https://doi.org/10.5772/intechopen.83024 ElHawary H, Baradaran A, Abi-Rafeh J, Vorstenbosch J, Xu L, dan, Efanov JI. (2021) Bone healing and inflammation: Principles of fracture and repair. Semin Plast Surg 35(3):198–203. https://doi.org/10.1055/s-0041-1732334 Islam O, Soboleski D, Symons S, Davidson LK, Ashworth MA, dan, Babyn P. (2000) Development and duration of radiographic signs of bone healing in children, AJR Am J Roentgenol 175(1):75–78. https://doi.org/10.2214/ajr.175.1.1750075 Sukegawa S, Masui M, Kanno T, Miki M, Nakamoto H, Furuki Y. Evaluation of open reduction and internal fixation of mandibular condyle fracture by intraoperative cone-beam computed tomography in a hybrid operating room. J Craniofac Surg. 2020;31(3):762–5. https://doi.org/10.1097/SCS.0000000000006101 . Liu Y, Zhang Xdan, Li X. Evaluation of mandibular bone density using radiographic techniques: A comparative study of QCT, DXA, and conventional radiography. J Oral Imaging. 2022;38(4):420–8. Singh KV, Tiwari R, Thanvi G, Chaurasia V, Kansara JD, dan Aggarwal R. Mandible Fracture Healing Assessment with all new Radiographic Union Scale of Mandible (RUSM)- An in-vivo study. Univ J Maxillofac Oral Sci. 2021;1(1):57–60. Niam B, Subroto IMI, Prasetyowati dan, S. A. D. Analysis of Bone Fracture Detection Based on Harris Corner Detector Method. J Telemat Inf. 2018;6(2):102–9. https://doi.org/10.12928/jti.v6i1 . Shirvaikar M, Dong N, Huang N. The measurement of bone quality using gray level co-occurrence matrix textural features. J Med Imaging Health Inf. 2016;6(5):1368–73. https://doi.org/10.1166/jmihi.2016.1812 . Liu Q, Mei H, Zhu G, Liu Z, Guo H, Wang M, Liang J, Zhang Y. 2022. Early pixel value ratios to assess bone healing during distraction osteogenesis. Frontiers in Bioengineering and Biotechnology, 10, p.929699. Geiger M, Blem G, dan Ludwig A. Evaluation of ImageJ for relative bone density measurement and clinical application. J Oral Health Craniofac Sci. 2016;1(1):12–21. http://dx.doi.org/10.29328/journal.johcs.1001002 . Yuhe S, Kong L, Weimin S, Chen X. A Study to Evaluate the Extent of Bone Healing in Mandibular Distraction Osteogenesis using Preoperative and Postoperative Pixel Value Ratio. Res Square. 2023;2–3. https://doi.org/10.21203/rs.3.rs-3099152/v1 . Tahrir LOA, Chanda MH, Fauzi A. (2024) Quality of Life Patients Mandibular Angulus Fracture Open Reduction and Rigid Internal Fixation Management: A Systematic Review. J Int Dent Med Res 17(3). Kozakiewicz M, Walczyk A. Current frequency of mandibular condylar process fractures. J Clin Med. 2023;12(4):1394. https://doi.org/10.3390/jcm12041394 . Roode GJ. Mandibular fractures: an epidemiological survey at the Oral and Dental Hospital, Pretoria: scientific. SADJ. 2007;62(6):270–4. Abdel-Mageed AM, Abdellatif MM, Intisar IK, Shahhat IM, Abu-Tahon MA, Abdein MA, Ali ZA. Inflammatory immune response and its key roles in the process of bone fractures healing. Edelweiss Appl Sci Technol. 2024;8(6):8023–8. https://doi.org/10.55214/25768484.v8i6.3738 . Maruyama M, Rhee C, Utsunomiya T, Zhang N, Ueno M, Yao Z, Goodman SB. Modulation of the inflammatory response and bone healing. Front Endocrinol. 2020;11:386. https://doi.org/10.3389/fendo.2020.00386 . Olate S, Vásquez B, Sandoval C, Vasconcellos A, Alister JP, Del Sol M. Histological analysis of bone repair in mandibular body osteotomy using internal fixation system in three different gaps without bone graft in an animal model. BioMed Res Int. 2019;2019(1). https://doi.org/10.1155/2019/8043510 . Sheen JR, Mabrouk A, dan, Garla VV. (2023) Fracture healing overview. In StatPearls [Internet] . StatPearls Publishing. Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures: A retrospective study. J Craniomaxillofac Surg. 2021;49:196–205. https://doi.org/10.1016/j.jcms.2020.12.013 . Pandey S, Simre SS, Srinivedha CV, Chaulagain RS, Vyas A, Basnet A. Open reduction internal fixation versus closed reduction for the management of mandibular intra-capsular fractures in adult patients: A systematic review and meta-analysis. J Oral Maxillofacial Surg Med Pathol. 2025;37:255–62. https://doi.org/10.1016/j.ajoms.2024.08.018 . Fardhani A, Rizqiawan A, Mulyawan I, Anugraha G. Comparison outcome of open and close reduction treatments for parasymphysis mandibular fractures. Dent J. 2023;56(4):268–72. https://doi.org/10.20473/j.djmkg.v56.i4.p268-272 . Monarchi G, Catarzi L, Paglianiti M, Valassina D, Balercia P, Consorti G. A comparative analysis of surgical and conservative management in intra-articular condylar fractures: A retrospective study. Surgeries. 2024;5(4):1033–42. https://doi.org/10.3390/surgeries5040083 . Ziauddin L, Krivicich LM, Nho SJ, Setia DKT, Chandra DIK, Irianto SY. (2023, August). Pengaruh Dimensi Pengalaman Pasca Pembelian Dalam Belanja Online Terhadap Kepuasan Pelanggan (Studi Pada Pengguna SHOPEE Di Bandar Lampung). In Prosiding Seminar Nasional Darmajaya 1:304–321. Setia DKT, Chandra DIK, Irianto SY. (2023) Pengaruh Dimensi Pengalaman Pasca Pembelian Dalam Belanja Online Terhadap Kepuasan Pelanggan (Studi Pada Pengguna SHOPEE Di Bandar Lampung). Prosiding Seminar Nasional Darmajaya (Vol. 1, pp. 304–321). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7613590","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530485938,"identity":"1fd492ef-8b26-40a8-b848-7a74c1c438ab","order_by":0,"name":"Ainu Zuhad Sukaton","email":"","orcid":"","institution":"Gadjah Mada University","correspondingAuthor":false,"prefix":"","firstName":"Ainu","middleName":"Zuhad","lastName":"Sukaton","suffix":""},{"id":530485941,"identity":"0160e27d-03b3-438d-8a93-d430065f7972","order_by":1,"name":"Poerwati Soetji Rahajoe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABMklEQVRIie2RMUvDQBTH33HQLC9kPaHErxAJtDrlqyiFukQcBEEUDQjtcnQW1K/hnBJIl5slcEula4dAQYJU8S6NUuwVHAXvN1zg8n689/4HYLH8YbD5MHA4kOnXdYpbjQCbCgYogAa/UZoK3UhAi/3svk7Xuc0XeLVsg5eNZ2V7HxAnz5f49gTeMCXpfFM54HnvHnM1GOv3gnowl59LdySBiUMYPxgmKuKQxi2tYIdpJfKwL10uAQqAzDBYUJwuaPyhFE90q7qLUs60srtViSk9GejE4s4qMXeYU6yk+mVW1C4hfR+F9S5MaAUF3XlMJO6Jo8S0i0psRu5e/UgnVl7wa6Ucv5TzpfT9SZaVhsS+Hy1K1UE43CSAAZCBfhGSbApryopKH84UYGkqtlgsln/KJ4YSYnpXzgcyAAAAAElFTkSuQmCC","orcid":"","institution":"Gadjah Mada University","correspondingAuthor":true,"prefix":"","firstName":"Poerwati","middleName":"Soetji","lastName":"Rahajoe","suffix":""},{"id":530485942,"identity":"5fb18cb5-87f7-4e9d-b7e3-fdad19f5fd04","order_by":2,"name":"Yosaphat Bayu Rosanto","email":"","orcid":"","institution":"Gadjah Mada 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16:51:14","extension":"html","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97815,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/36854827f70f6147ec3094ef.html"},{"id":93881816,"identity":"38bf0d28-5aeb-4e90-b4ca-26d5ed487482","added_by":"auto","created_at":"2025-10-19 16:51:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264896,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Determination of ROI on the fracture line of the ORIF group comprising ROI 1 and ROI 2. (B) Determination of ROI on healthy bone of the ORIF group consisting of ROI 3 to ROI 6.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/483ce8eb0dab5d815f34cffe.png"},{"id":93881815,"identity":"b6303399-95a9-49a4-8f4f-d5f5fbb81beb","added_by":"auto","created_at":"2025-10-19 16:51:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":174634,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Determination of ROI on the closed reduction superimposed fracture line, which are ROI 1 and ROI 2 (B) Determination of ROI on healthy bone closed reduction superimposed, which are ROI 3 to ROI 6.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/7d43d113f2fb0aaf08bb409c.png"},{"id":93881814,"identity":"70a068a0-4d1c-4f4a-b9bf-7f7ced523278","added_by":"auto","created_at":"2025-10-19 16:51:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":328980,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Determination of ROI on the fracture line of the non-superimposed closed reduction group, which are ROI 1 to ROI 4 (B) Determination of ROI on healthy bone in the non-superimposed closed reduction group, which are ROI 5 to ROI 8.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/a7feeb98c38f174a392bdcf7.png"},{"id":93881818,"identity":"d7f63e65-cb68-41e1-ba95-784e71d5dd72","added_by":"auto","created_at":"2025-10-19 16:51:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":261400,"visible":true,"origin":"","legend":"\u003cp\u003eGSV value based on observation time in the fracture group and non-fracture group with P based on the independent T-test.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/412663a35ba74ce1c8d55dc6.png"},{"id":93881831,"identity":"61a75e02-7aad-410c-90db-98b8de665eff","added_by":"auto","created_at":"2025-10-19 16:51:14","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":153953,"visible":true,"origin":"","legend":"\u003cp\u003ePVR value for the ORIF and closed reduction groups with P and R based on Pearson's correlation test.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/efc3b6c3704ab780d4836c25.png"},{"id":95312228,"identity":"8b19eae6-f751-449a-aeb6-4b2eb98d3216","added_by":"auto","created_at":"2025-11-06 15:48:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1958032,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/f081056b-fae1-4892-a54b-9579593cf7a3.pdf"},{"id":93883248,"identity":"cc20c072-09b5-47cb-afdd-d533d97dab73","added_by":"auto","created_at":"2025-10-19 16:59:13","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":242502,"visible":true,"origin":"","legend":"","description":"","filename":"SubmissionChecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7613590/v1/95676dab7a690ae72c0421b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Compared Healing of Mandibular Condylar Fractures with Open and Closed Reduction Surgical Methods (Radiological Analysis, Gray Scale)","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMandibular condylar fractures are the most common type of mandibular fracture, marking 52% of all mandibular fractures [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The management of condylar fracture remains in questions which one is better between open reduction internal fixation (ORIF) and closed methods. The ORIF method is more commonly used because it can reduce the duration of maxillomandibular fixation (MMF) placement, where patients are more comfortable, oral hygiene is easier to maintain, and jaw mobilization is faster. However, this method has several weaknesses such as the risk of facial nerve injury and postoperative infection. On the other hand, the closed method has the advantage of being more conservative and causing minimal risk, but the duration of MMF placement is longer which causes discomfort for the patient [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBone healing in condylar fractures treated with ORIF is primary healing, referring to the healing process that occurs when bone fragments are reduced and fixed properly [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], radiologically 2\u0026ndash;4 weeks after the fracture, the bone density increases at the fracture margin, indicating the formation of new bone that occurs until week 8 when the fracture line is eliminated [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Secondary bone healing occurs in fractures treated with the closed method, which takes place indirectly through the acute inflammatory process in the formation of hematoma, then undergoes coagulation and callus formation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], radiologically, secondary healing occurs and emerges from the formation of callus at the fracture margin, which can be found between 2\u0026ndash;4 four weeks after the fracture [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe most common study on condylar fracture healing is clinical evaluation. Radiographic evaluation of condylar fracture healing remains rare. Sukegawa's study [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] found good alignment in ORIF treatment compared to the non-fractured side using intraoperative CBCT. Meanwhile, according to Zhang [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], alignment was achieved but roughness occurred on the condylar surface using panoramic radiography. In contrast to these two researchers, Singh's study [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] showed that the visibility of the fracture line gradually disappeared three months after ORIF on panoramic radiographic examination. Unluckily, these studies cannot assess the stages of the bone healing process, and can only see the final results of treatment and are more subjective.\u003c/p\u003e\u003cp\u003eGray scale is a radiographic analysis to assess bone density by evaluating changes in gray gradation, thereby enabling a more objective assessment of the stages of the healing process. Gray scale analyzes the gray scale of each pixel on a radiograph with the help of digital image processing software for assessing bone density and bone thickness [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Shirvaikar [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] used grayscale analysis to study bone mineral density in long bones as a parameter for predicting fracture risk. Liu [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] used gray scale analysis to observe the distraction osteogenesis process using AP lateral radiographs. Another research group assessed the difference in the number of plates and the use of archbars on bone healing in parasymphyseal fractures using grayscale (in publication process) which found that there was no difference in fracture healing between the use of single plate combined with an archbar compared to that of two miniplates without an archbar and two miniplates with an archbar.\u003c/p\u003e\u003cp\u003eNo studies have been done on the healing of mandibular condylar fractures using grayscale analysis to assess the healing process of mandibular condylar fractures treated with ORIF and closed methods. This study aimed at observing the differences between the stages of bone healing in cases of mandibular condylar fractures treated with ORIF and closed methods.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e This retrospective cross-sectional study was conducted after obtaining approval from the Ethics Committee of the Faculty of Dentistry\u0026ndash;Dental and Oral Hospital, Universitas Gadjah Mada (41/UN1/KEP/FKG-RSGM/EC/2025). The research samples were taken at Margono Soekarjo Regional General Hospital, Purwokerto, Central Java, Indonesia, and radiographic analysis was performed at Prof. Soedomo Dental Hospital, Faculty of Dentistry, Universitas Gadjah Mada. The evaluation of the healing process of mandibular condylar fractures using Gray Scale Value (GSV) and Pixel Value Ratio (PVR) analysis was performed by a radiology specialist (SFD) on OPG following the predetermined Region of Interest (ROI).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eResearch Samples\u003c/h2\u003e\u003cp\u003e The research samples consist of medical records of patients diagnosed with condylar fractures treated between 2017 and 2024, with inclusion criteria: (a) Complete patient medical records, (b) Patients had orthopantomography (OPG) X-rays, (c) OPG radiograph quality is eligible for analysis, and (d) Patients had no systemic diseases. Exclusion criteria comprise: (a) Patients with infectious complications and (b) Patients with pathological causes of fracture.\u003c/p\u003e\u003cp\u003eThirty (30) samples involved in this study were calculated using an unpaired numerical analytical formula with 80% research power and a 95% confidence level with a minimum sample size of 15 per group:\u003c/p\u003e\u003c/div\u003e\n\u003cdiv class=\"Heading\"\u003en1\u0026thinsp;=\u0026thinsp;n2 = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:2{\\left(\\frac{\\left(Z\\propto\\:+Z\\beta\\:\\right)S}{X1-X2}\\right)}^{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eZα : alpha standard deviation with a confidence level of 95% or α\u0026thinsp;=\u0026thinsp;5%\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003eZβ : beta standard deviation\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section4\"\u003e\u003ch2\u003eS : combined standard deviation\u003c/h2\u003e\u003cp\u003eX1-X2 : minimum difference in significant means\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eDetermination of Region of Interest (ROI) (Figs. , , and )\u003c/h3\u003e\n\u003cp\u003eThe size of each ROI is 10x10 pixels (100 pixels). The determination of the ROI for the ORIF group differs from the one for the closed method group in order to minimize bias that may occur due to the determination of ROI [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In the ORIF group, 6 ROIs were determined: 2 ROIs on the fracture line, 2 ROIs on healthy bone in the superior and inferior fracture lines on the anterior plate, and another 2 ROIs on the healthy bone side in the superior and inferior fracture lines on the posterior plate (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eROI in the closed method group was determined in two ways consisting of superimposed and non-superimposed. In the superimposed case, the average ROI in the fracture area was calculated from ROI 1 and 2, then the average ROI in the non-fracture area was calculated from the average ROI 3, 4, 5, and 6. The average of the ROI in the fracture area and the non-fracture area becomes the average grayscale value (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In the non-superimposed case, there are 8 ROIs, in which 4 ROIs on the fracture line of the condyle and mandibular ramus and 4 ROIs in the non-fractured bone area on the condyle and mandibular ramus fragments. The average of ROI 1 to ROI 4 is the average gray scale value in the fracture area, while the average of ROI 5 to ROI 8 is the average gray scale value in the non-fracture area (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eGray Scale Value (GSV)\u003c/b\u003e \u003cb\u003eAnalysis (Geiger,2016)\u003c/b\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eGray Scale Value (GSV) analysis on OPG radiographs used Image-J\u0026reg; software (Wayne Rasband, NIH, USA). Prior to performing GSV analysis, the OPG radiograph was first resized to 2976 x 1536 pixels and then converted to 8-bit image data with the conversion menu in Image-J to make sure that the OPG radiograph had 256 gray values ranging from 0 to 255, where 0 was black and 255 was white. GSV analysis was conducted on OPGs on observation day 1, week 2, weeks 8\u0026ndash;13, and \u0026gt;\u0026thinsp;13 weeks postoperatively.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePixel Value Ratio\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003ePVR\u003c/b\u003e\u003cb\u003e) Analysis (Geiger,2016)\u003c/b\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe Pixel Value Ratio (PVR) method is a technique for analyzing grayscale images by systematically observing changes in pixel values. PVR is an approach that emphasizes measuring the range of pixel values in grayscale images to identify variations in intensity and contrast. This technique can detect edges, contours, or patterns relevant to specific clinical conditions. The calculation of PVR was carried out on observation day 1, week 2, weeks 8\u0026ndash;13, and \u0026gt;\u0026thinsp;13 weeks postoperatively using the following formula:\u003c/p\u003e\u003cp\u003ePVR\u0026thinsp;=\u0026thinsp;GSV fracture/GSV healthy bone\u003c/p\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe obtained data were analyzed with IBM SPSS Statistics 22 (IBM, United States). In this study, normal data distribution and sphericity of variance were fulfilled. The GSV and PVR data in the ORIF group and the closed reduction group were tested using Repeated Measure ANOVA (Analysis of Variance) based on observation time to identify the differences between the two groups and T-test to see the differences at each observation time between the ORIF and closed reduction groups. Pearson's correlation test was performed to determine the relationship between the increase in PVR and the observation time.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eResearch Sample Characteristics\u003c/h2\u003e\u003cp\u003eThe research subjects were predominantly male in both groups, with an average patient age of 28.1 and 26.9 respectively, and no significant differences were found between the two groups. Similarly, other characteristics such as waiting time for surgery, etiology, operating time, and displacement showed no significant differences between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The observation period was conducted on day 1, week 2, weeks 8\u0026ndash;13, and \u0026gt;\u0026thinsp;13 weeks postoperatively (9.1 weeks on average), and more than 13 weeks postoperatively with an average observation time of 24.4 weeks.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Research Subjects (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eClosed reduction\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender, N,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (66.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (66.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (33.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWaiting time for Treatment, N,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (46.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 3 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (46.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (53.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEtiology, N,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple Traffic Accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (66.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle Traffic Accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (33.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperating time, N,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (46.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (46.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Fragment Condition, N,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisplacement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (66.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithout displacement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (46.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eP: based on the chi-square test with α\u0026thinsp;=\u0026thinsp;95%\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eGrey Scale Value (GSV)\u003c/h2\u003e\u003cp\u003eGSV value on the fracture side in both the ORIF group (P\u0026thinsp;=\u0026thinsp;0.015) and the closed reduction group (P\u0026thinsp;=\u0026thinsp;0.000) showed a significant increase based on the observation time. When comparing the ORIF and closed reduction groups, the GSV value in the non-fracture area for both the ORIF and closed reduction groups revealed no significant increase based on observation time, with P value of 0.813 and 0.211 respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In contrast to the GSV value in the non-fracture area, the mean GSV value in the fracture area in the ORIF group (121.16-135.38) was higher than that in the closed reduction group (105.25\u0026ndash;134) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The higher GSV value in the fracture area in the ORIF group indicated a faster trabecular bone formation process, indicating faster healing.\u003c/p\u003e\u003cp\u003eOn the fracture side, the GSV value of the ORIF group was higher than that of the closed reduction group, but a significant difference was found only on day 1. The non-fracture side showed no significant differences based on all observation times.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAverage GSV Score in the ORIF and Closed Reduction Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFollow-up Time\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eFracture (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eNon Fracture (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClosed reduction\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eClosed reduction\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e121,16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105.25\u0026thinsp;\u0026plusmn;\u0026thinsp;11.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e145.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e139.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.201\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124.09\u0026thinsp;\u0026plusmn;\u0026thinsp;12.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121.65\u0026thinsp;\u0026plusmn;\u0026thinsp;17.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.655\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e141.01\u0026thinsp;\u0026plusmn;\u0026thinsp;14.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e143.35\u0026thinsp;\u0026plusmn;\u0026thinsp;19.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.718\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeeks 8\u0026ndash;13 (9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131.72\u0026thinsp;\u0026plusmn;\u0026thinsp;16.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125.81\u0026thinsp;\u0026plusmn;\u0026thinsp;14.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.318\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e142.57\u0026thinsp;\u0026plusmn;\u0026thinsp;20.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e139.87\u0026thinsp;\u0026plusmn;\u0026thinsp;16.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.701\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;13 weeks (24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e135.38\u0026thinsp;\u0026plusmn;\u0026thinsp;11.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134\u0026thinsp;\u0026plusmn;\u0026thinsp;15.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e141.89\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e143.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16,98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.739\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.015*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eDescription:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eP\u003csup\u003e1\u003c/sup\u003e: Based on Repeated Measure Anova test,\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eP\u003csup\u003e2\u003c/sup\u003e: based on independent T test with α\u0026thinsp;=\u0026thinsp;95%.\u003c/p\u003e\u003cp\u003e*: Significant\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePixel Value Ratio (PVR)\u003c/h2\u003e\u003cp\u003eEvaluation of PVR at each observation time on day 1, week 2, weeks 8\u0026ndash;13, and \u0026gt;\u0026thinsp;13 weeks showed that PVR value increased (ORIF from 0.84 to 0.95 and closed reduction from 0.75 to 0.93 with P value of 0.00 and 0.00, respectively), with higher PVR value in the ORIF group. In this study, PVR value in the ORIF group was proven to be higher at all observation times (day 1 showed ORIF 0.84 and closed reduction 0.75 with P\u0026thinsp;=\u0026thinsp;0.001), (week 2 revealed ORIF 0.88 and closed reduction 0.85 with P\u0026thinsp;=\u0026thinsp;0.003), (weeks 8 to 13 showed ORIF 0.93 and closed reduction 0.90 with P\u0026thinsp;=\u0026thinsp;0.005) and (\u0026gt;\u0026thinsp;13 weeks revealed ORIF 0.95 and closed reduction 0.93 with P\u0026thinsp;=\u0026thinsp;0.018)) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Pearson's correlation test showed a strong positive relationship between the increase in PVR and the observation time in the ORIF group (P\u0026thinsp;=\u0026thinsp;0.000 and R\u0026thinsp;=\u0026thinsp;0.866) and the closed reduction group (P\u0026thinsp;=\u0026thinsp;0.000 and R\u0026thinsp;=\u0026thinsp;0.874), which means that as time increased, the PVR value in both groups also increased (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAverage PVR Score in the ORIF and Closed Reduction Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFollow-up Time (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePVR (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eClosed reduction\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeeks 8\u0026ndash;13\u003c/p\u003e\u003cp\u003e(9.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.005**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;13 weeks\u003c/p\u003e\u003cp\u003e(24.42\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.018*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eDescription :\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eP\u003csup\u003e1\u003c/sup\u003e: based on Repeated Measure ANOVA test,\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eP\u003csup\u003e2\u003c/sup\u003e: based on independent T test with α\u0026thinsp;=\u0026thinsp;95%.\u003c/p\u003e\u003cp\u003e* : Significant\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eProper treatment method for mandibular condylar fractures can result in faster healing, thereby preventing complications such as malocclusion, temporomandibular joint (TMJ) disorders, limited mandibular movement, and chronic pain [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] which can promote the patient's quality of life, reduce treatment costs, and shorten the duration of treatment. This study aimed at evaluating the differences in radiographic healing of mandibular condylar fractures between the ORIF and closed reduction methods.\u003c/p\u003e\u003cp\u003eThe subjects involved in the study were predominantly male (66.67%) aged 26\u0026ndash;28 years with mandibular condylar fractures by traffic accidents. The results are similar to those of a study conducted by Kozakiewicz and Walczyk [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], that in developed countries, the case was more frequently in male (82%) with an average age of 33\u0026ndash;40 years, but the etiology of mandibular condylar fractures is mostly caused by physical violence (51%). This difference in etiology is due to sociocultural differences between developed and developing countries, as stated in Roode's study\u0026sup1;\u003csup\u003e5\u003c/sup\u003e that most people in developing countries use motorcycles as the main means of transportation.\u003c/p\u003e\u003cp\u003eThe results of this study showed that GSV value on the fracture side after treatment with ORIF was significantly higher than that obtained with the closed reduction method only on the first day of GSV observation (P\u0026thinsp;=\u0026thinsp;0.001). Meanwhile, at week 2 (P\u0026thinsp;=\u0026thinsp;0.655), 8 to 13 weeks (P\u0026thinsp;=\u0026thinsp;0.318), and \u0026gt;\u0026thinsp;13 weeks (P\u0026thinsp;=\u0026thinsp;0.787), the GSV value of the ORIF group was higher than that of the closed reduction group but it was not significant. The results indicate that on day 1, the ORIF group had higher bone density compared to the closed reduction group, because in ORIF treatment, no gap was formed in the fracture area, thereby increasing radiopacity and GSV value, as stated in Liu's study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTreatment with ORIF is dominated by primary bone healing, through the remodeling of bone lamellae and Haversian canals due to the achieved reduction and fixation of fractured bones [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The bone on one side will come into contact with the other side to achieve mechanical continuity, then Haversian canals will form in the fracture area to fill the fracture area with bone matrix. This process allows for bone formation and new blood supply in the fracture area, which then transitions to the remodeling phase without the formation of callus [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe healing process of fractures in the closed reduction method occurs through secondary bone healing. Secondary bone healing undergoes four stages: on the first stage, acute inflammation occurs during the first five days, where hematoma forms and inflammatory mediators recruit inflammatory cells to clean up necrotic tissue; the second stage occurs on days 5\u0026ndash;10, marked by the formation of soft callus; the third stage is the process of hard callus formation, which lasts until the fourth week [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The final phase is bone remodeling, which can last from months to years through the activity of osteoclasts and osteoblasts. This phase aims to restore the bone to its original structure, shape, and mechanical properties [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eObservation of fracture healing using GSV analysis with the ImageJ software is easier and cheaper to perform, as well as more sensitive and objective in assessing changes in the degree of grayness that identify bone density conditions in radiographs in the bone formation process [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. GSV analysis, however, depends on the quality of the radiograph image used and can vary in each parameter, such as contrast, voltage, current, exposure time, and patient position. The parameters can affect the quality of the radiograph image, resulting in the possibility of bias in the calculation. This study took samples from the same radiography laboratory and were examined by the same radiologist, and used PVR analysis to anticipate the weaknesses of GSV analysis to minimize bias.\u003c/p\u003e\u003cp\u003eThe healing process analysis in this study used the Pixel Value Ratio (PVR), which compares the GSV value on the fracture side with the healthy side to make it more representative per individual [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The PVR value in this study showed higher value in the ORIF group compared to the closed reduction group on all observation days: day 1, week 2, weeks 8 to 13, and \u0026gt;\u0026thinsp;13 weeks postoperatively with P value of P\u0026thinsp;=\u0026thinsp;0.001, P\u0026thinsp;=\u0026thinsp;0.003, P\u0026thinsp;=\u0026thinsp;0.005, and P\u0026thinsp;=\u0026thinsp;0.018, respectively, indicating earlier bone remodeling process in the ORIF group. The bone composition in the fracture area was denser, and the fracture line disappeared more quickly compared to the closed reduction group. This process indicates that the bone healing process was faster in the ORIF group [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe highest increase in PVR was found in the ORIF control group from week 2 to weeks 8 to 13 (0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u0026ndash;0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03), while in the closed reduction group it was found from day 1 to week 2 (0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u0026ndash;0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03). The difference in PVR increase between the two groups occurred because in the closed reduction group, inflammation and hematoma formation as a scaffold in the callus formation process occurred from day 1 to day 5. then from day 5 to day 10 soft callus was formed, followed by mineralization of the soft callus into hard callus, which continued until the fourth week of the fracture, causing the PVR value to increase significantly because the fracture gap began to fill with callus, which increased radioopacity. In contrast, the ORIF group did not undergo the callus formation process because there was no gap, so primary healing occurred from the first day of the fracture after treatment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe highest increase in the ORIF group was observed in week 2\u0026ndash;8 due to the maturation process of woven bone into lamellar bone\u003csup\u003e3,16\u003c/sup\u003e that increased radioopacity in the fracture area and was reflected in high PVR increase. Meanwhile, in the closed reduction group, week 2\u0026ndash;8 marked the beginning of the bone remodeling process, resulting in a slowdown in PVR increase.\u003c/p\u003e\u003cp\u003eThe results of this study also support previous studies that examined clinical fracture healing, such as Rashid's study [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] which showed that the ORIF group had lower pain complications and wider mouth opening compared to the closed reduction group in the treatment of mandibular condylar fractures. Bansal [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] found a wider interincisal opening in patients with condylar fractures treated with ORIF compared to closed reduction. The same findings were also reported by Pandey [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] who found that the incidence of TMJ dysfunction and malocclusion after ORIF treatment was lower than that after closed reduction. This study also showed that PVR was found higher in the ORIF group than in the closed reduction group.\u003c/p\u003e\u003cp\u003eBased on this description, it does not mean that treatment with closed reduction was worse than ORIF in cases of mandibular condyle fractures, because in some cases treatment with the ORIF method was impossible to carry out [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The choice of treatment method for mandibular condylar fractures is influenced by the indications and contraindications of each case, the patient's age, the severity of the fracture, and the condition of the patient's teeth [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The ORIF method may be preferable in certain cases, such as mandibular condylar neck fractures with minimal displacement and single-fragment fractures. Still, a more conservative approach using closed reduction remains a prudent choice in cases such as condylar head fractures, non-displaced condylar fractures, and condylar fractures in pediatric patients [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis retrospective cross-sectional study has several limitations, such as the inability to control variables that may affect fracture healing, including age range, fracture severity, surgical technique, observation time, and length of treatment, due to the use of secondary data. The samples in this study were taken over a specific period of time, restricting the ability to observe variables that affect bone healing over time [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAnalysis of Gray Scale Value (GSV) and Pixel Value Ratio (PVR) showed higher value in the ORIF group compared to closed reduction. This value indicates that the ORIF group had higher bone density (consisting of lamellar bone in the ORIF group and callus in the closed reduction group) during the bone healing process, meaning that the healing process of mandibular condylar fractures in the ORIF group was better than in the closed reduction group.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest\u003c/h2\u003e\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculty of Dentistry\u0026ndash;Dental and Oral Hospital, Universitas Gadjah Mada (41/UN1/KEP/FKG-RSGM/EC/2025).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003cp\u003e Additional informed consent was obtained from all patients for which identifying information is included in this article.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAZS wrote a manuscript, PSR designed a research method and proposed a statistical method, AZS performed data collection and analysis, and PSR, YBR supervised the research. The authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eNil\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRashid M, Dhiman NK, Kumar N, Tiwari P, Jaiswara C, Vishwakarma AK, Shweta S, Hirani MS. Evaluation of condylar fractures management: Open vs. closed. IJDSIR. 2020;3(5):27\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDergin G, Emes Y, dan, Aybar B. (2019) Evaluation and management of mandibular fracture, Trauma in Dentistry, IntechOpen. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5772/intechopen.83024\u003c/span\u003e\u003cspan address=\"10.5772/intechopen.83024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElHawary H, Baradaran A, Abi-Rafeh J, Vorstenbosch J, Xu L, dan, Efanov JI. (2021) Bone healing and inflammation: Principles of fracture and repair. Semin Plast Surg 35(3):198\u0026ndash;203. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1055/s-0041-1732334\u003c/span\u003e\u003cspan address=\"10.1055/s-0041-1732334\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIslam O, Soboleski D, Symons S, Davidson LK, Ashworth MA, dan, Babyn P. (2000) Development and duration of radiographic signs of bone healing in children, AJR Am J Roentgenol 175(1):75\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2214/ajr.175.1.1750075\u003c/span\u003e\u003cspan address=\"10.2214/ajr.175.1.1750075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSukegawa S, Masui M, Kanno T, Miki M, Nakamoto H, Furuki Y. Evaluation of open reduction and internal fixation of mandibular condyle fracture by intraoperative cone-beam computed tomography in a hybrid operating room. J Craniofac Surg. 2020;31(3):762\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/SCS.0000000000006101\u003c/span\u003e\u003cspan address=\"10.1097/SCS.0000000000006101\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Y, Zhang Xdan, Li X. Evaluation of mandibular bone density using radiographic techniques: A comparative study of QCT, DXA, and conventional radiography. J Oral Imaging. 2022;38(4):420\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh KV, Tiwari R, Thanvi G, Chaurasia V, Kansara JD, dan Aggarwal R. Mandible Fracture Healing Assessment with all new Radiographic Union Scale of Mandible (RUSM)- An in-vivo study. Univ J Maxillofac Oral Sci. 2021;1(1):57\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNiam B, Subroto IMI, Prasetyowati dan, S. A. D. Analysis of Bone Fracture Detection Based on Harris Corner Detector Method. J Telemat Inf. 2018;6(2):102\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12928/jti.v6i1\u003c/span\u003e\u003cspan address=\"10.12928/jti.v6i1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShirvaikar M, Dong N, Huang N. The measurement of bone quality using gray level co-occurrence matrix textural features. J Med Imaging Health Inf. 2016;6(5):1368\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1166/jmihi.2016.1812\u003c/span\u003e\u003cspan address=\"10.1166/jmihi.2016.1812\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Q, Mei H, Zhu G, Liu Z, Guo H, Wang M, Liang J, Zhang Y. 2022. Early pixel value ratios to assess bone healing during distraction osteogenesis. Frontiers in Bioengineering and Biotechnology, 10, p.929699.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeiger M, Blem G, dan Ludwig A. Evaluation of ImageJ for relative bone density measurement and clinical application. J Oral Health Craniofac Sci. 2016;1(1):12\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.29328/journal.johcs.1001002\u003c/span\u003e\u003cspan address=\"10.29328/journal.johcs.1001002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYuhe S, Kong L, Weimin S, Chen X. A Study to Evaluate the Extent of Bone Healing in Mandibular Distraction Osteogenesis using Preoperative and Postoperative Pixel Value Ratio. Res Square. 2023;2\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.21203/rs.3.rs-3099152/v1\u003c/span\u003e\u003cspan address=\"10.21203/rs.3.rs-3099152/v1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTahrir LOA, Chanda MH, Fauzi A. (2024) Quality of Life Patients Mandibular Angulus Fracture Open Reduction and Rigid Internal Fixation Management: A Systematic Review. J Int Dent Med Res 17(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKozakiewicz M, Walczyk A. Current frequency of mandibular condylar process fractures. J Clin Med. 2023;12(4):1394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm12041394\u003c/span\u003e\u003cspan address=\"10.3390/jcm12041394\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoode GJ. Mandibular fractures: an epidemiological survey at the Oral and Dental Hospital, Pretoria: scientific. SADJ. 2007;62(6):270\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdel-Mageed AM, Abdellatif MM, Intisar IK, Shahhat IM, Abu-Tahon MA, Abdein MA, Ali ZA. Inflammatory immune response and its key roles in the process of bone fractures healing. Edelweiss Appl Sci Technol. 2024;8(6):8023\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.55214/25768484.v8i6.3738\u003c/span\u003e\u003cspan address=\"10.55214/25768484.v8i6.3738\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaruyama M, Rhee C, Utsunomiya T, Zhang N, Ueno M, Yao Z, Goodman SB. Modulation of the inflammatory response and bone healing. Front Endocrinol. 2020;11:386. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fendo.2020.00386\u003c/span\u003e\u003cspan address=\"10.3389/fendo.2020.00386\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlate S, V\u0026aacute;squez B, Sandoval C, Vasconcellos A, Alister JP, Del Sol M. Histological analysis of bone repair in mandibular body osteotomy using internal fixation system in three different gaps without bone graft in an animal model. BioMed Res Int. 2019;2019(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2019/8043510\u003c/span\u003e\u003cspan address=\"10.1155/2019/8043510\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSheen JR, Mabrouk A, dan, Garla VV. (2023) Fracture healing overview. In \u003cem\u003eStatPearls [Internet]\u003c/em\u003e. StatPearls Publishing.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures: A retrospective study. J Craniomaxillofac Surg. 2021;49:196\u0026ndash;205. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcms.2020.12.013\u003c/span\u003e\u003cspan address=\"10.1016/j.jcms.2020.12.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePandey S, Simre SS, Srinivedha CV, Chaulagain RS, Vyas A, Basnet A. Open reduction internal fixation versus closed reduction for the management of mandibular intra-capsular fractures in adult patients: A systematic review and meta-analysis. J Oral Maxillofacial Surg Med Pathol. 2025;37:255\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ajoms.2024.08.018\u003c/span\u003e\u003cspan address=\"10.1016/j.ajoms.2024.08.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFardhani A, Rizqiawan A, Mulyawan I, Anugraha G. Comparison outcome of open and close reduction treatments for parasymphysis mandibular fractures. Dent J. 2023;56(4):268\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.20473/j.djmkg.v56.i4.p268-272\u003c/span\u003e\u003cspan address=\"10.20473/j.djmkg.v56.i4.p268-272\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMonarchi G, Catarzi L, Paglianiti M, Valassina D, Balercia P, Consorti G. A comparative analysis of surgical and conservative management in intra-articular condylar fractures: A retrospective study. Surgeries. 2024;5(4):1033\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/surgeries5040083\u003c/span\u003e\u003cspan address=\"10.3390/surgeries5040083\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZiauddin L, Krivicich LM, Nho SJ, Setia DKT, Chandra DIK, Irianto SY. (2023, August). Pengaruh Dimensi Pengalaman Pasca Pembelian Dalam Belanja Online Terhadap Kepuasan Pelanggan (Studi Pada Pengguna SHOPEE Di Bandar Lampung). In \u003cem\u003eProsiding Seminar Nasional Darmajaya\u003c/em\u003e 1:304\u0026ndash;321.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSetia DKT, Chandra DIK, Irianto SY. (2023) Pengaruh Dimensi Pengalaman Pasca Pembelian Dalam Belanja Online Terhadap Kepuasan Pelanggan (Studi Pada Pengguna SHOPEE Di Bandar Lampung). Prosiding Seminar Nasional Darmajaya (Vol. 1, pp. 304\u0026ndash;321).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"mandibular condylar fracture, Gray Scale Value, ORIF, closed reduction","lastPublishedDoi":"10.21203/rs.3.rs-7613590/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7613590/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: This study aimed at comparing the bone healing process in mandibular condylar fractures treated with ORIF and closed reduction methods radiographically with the use of Gray Scale Value (GSV).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods:The study involved 30 patients with condylar fractures who were treated and divided into two groups: Group A: Treatment with ORIF (15 patients); Group B: Treatment with closed reduction (15 patients). GSV analysis on orthopantomography (OPG) was presented in Pixel Value Ratio (PVR), which compared GSV value of fracture area and healthy bone. Observations were made on day 1, week 2, weeks 8-13, and \u0026gt;13 weeks postoperatively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The majority of the subjects were male, 26-28 years of age on average, all with traffic accident trauma etiology. Results of repeated measure ANOVA showed that PVR value in both groups increased significantly at all observation times with P=0.000, and the PVR value in the ORIF group was higher. T-test results showed that PVR value in ORIF group was higher than closed reduction group at all observation times (0.001, 0.003, 0.005, and 0.018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: GSV and PVR values in ORIF group were found higher than those in closed reduction group, which means that healing in ORIF group was better than in closed reduction group.\u003c/p\u003e","manuscriptTitle":"Compared Healing of Mandibular Condylar Fractures with Open and Closed Reduction Surgical Methods (Radiological Analysis, Gray Scale)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-19 16:51:09","doi":"10.21203/rs.3.rs-7613590/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"359a4243-d2c3-43fd-837b-99f6e0c976c6","owner":[],"postedDate":"October 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-05T09:09:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-19 16:51:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7613590","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7613590","identity":"rs-7613590","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}